Team Assessment and Decision Making Is Associated With Outcomes: A Trauma Video Review Analysis.
Adult
Clinical Competence
Clinical Decision-Making
/ methods
Emergency Service, Hospital
/ organization & administration
Female
Heart Arrest
/ etiology
Humans
Injury Severity Score
Male
Middle Aged
Outcome and Process Assessment, Health Care
/ methods
Patient Care Team
/ organization & administration
Pennsylvania
Resuscitation
/ methods
Thoracotomy
/ methods
Trauma Centers
/ organization & administration
Video Recording
Wounds and Injuries
/ complications
Assessment
Resuscitation
T-NOTECHS
Teamwork
Trauma
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
25
04
2019
revised:
24
07
2019
accepted:
18
09
2019
pubmed:
23
10
2019
medline:
15
2
2020
entrez:
23
10
2019
Statut:
ppublish
Résumé
Teamwork is a critical element of trauma resuscitation. Assessment tools such as T-NOTECHS (Trauma NOn-TECHnical Skills) exist, but correlation with patient outcomes is unclear. Using emergency department thoracotomy (EDT), we sought to describe T-NOTECHS scores during resuscitations. We hypothesized that patients undergoing EDT whose resuscitations had better scores would be more likely to have return of spontaneous circulation (ROSC). Continuously recording video was used to review all captured EDTs over a 24-mo period. We used a modification of the validated T-NOTECHS instrument to measure five domains on a 3-point scale (1 = best, 2 = average, 3 = worst). A total T-NOTECHS score was calculated by one of three reviewers. The primary outcome was ROSC. ROSC was defined as an organized rhythm no longer requiring internal cardiac compressions. Associations between variables and ROSC were examined using univariate regression. Sixty-one EDTs were captured. Nineteen patients had ROSC (31%) and 42 (69%) did not. The median T-NOTECHS score for all resuscitations was 8 [IQR 6-10]. As demographic and injury data (age, gender, mechanism, signs of life) were not associated with ROSC in univariate analysis, they were not considered for inclusion in a multivariable regression model. The association between overall T-NOTECHS score and ROSC did not reach statistical significance, but examination of the individual components of the T-NOTECHS score demonstrated that, compared to resuscitations that had "average" (2) or "worst" (3) scores on "Assessment and Decision Making," resuscitations with a "best" score were 5 times more likely to lead to ROSC. Although the association between overall T-NOTECHS scores and ROSC did not reach statistical significance, better scores in the domain of assessment and decision making are associated with improved rates of ROSC in patients arriving in cardiac arrest who undergo EDT. Level IV Therapeutic/Care Management.
Sections du résumé
BACKGROUND
Teamwork is a critical element of trauma resuscitation. Assessment tools such as T-NOTECHS (Trauma NOn-TECHnical Skills) exist, but correlation with patient outcomes is unclear. Using emergency department thoracotomy (EDT), we sought to describe T-NOTECHS scores during resuscitations. We hypothesized that patients undergoing EDT whose resuscitations had better scores would be more likely to have return of spontaneous circulation (ROSC).
METHODS
Continuously recording video was used to review all captured EDTs over a 24-mo period. We used a modification of the validated T-NOTECHS instrument to measure five domains on a 3-point scale (1 = best, 2 = average, 3 = worst). A total T-NOTECHS score was calculated by one of three reviewers. The primary outcome was ROSC. ROSC was defined as an organized rhythm no longer requiring internal cardiac compressions. Associations between variables and ROSC were examined using univariate regression.
RESULTS
Sixty-one EDTs were captured. Nineteen patients had ROSC (31%) and 42 (69%) did not. The median T-NOTECHS score for all resuscitations was 8 [IQR 6-10]. As demographic and injury data (age, gender, mechanism, signs of life) were not associated with ROSC in univariate analysis, they were not considered for inclusion in a multivariable regression model. The association between overall T-NOTECHS score and ROSC did not reach statistical significance, but examination of the individual components of the T-NOTECHS score demonstrated that, compared to resuscitations that had "average" (2) or "worst" (3) scores on "Assessment and Decision Making," resuscitations with a "best" score were 5 times more likely to lead to ROSC.
CONCLUSIONS
Although the association between overall T-NOTECHS scores and ROSC did not reach statistical significance, better scores in the domain of assessment and decision making are associated with improved rates of ROSC in patients arriving in cardiac arrest who undergo EDT.
LEVEL OF EVIDENCE
Level IV Therapeutic/Care Management.
Identifiants
pubmed: 31635832
pii: S0022-4804(19)30678-X
doi: 10.1016/j.jss.2019.09.033
pmc: PMC8406277
mid: NIHMS1731893
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
544-549Subventions
Organisme : NHLBI NIH HHS
ID : K08 HL131995
Pays : United States
Organisme : NHLBI NIH HHS
ID : R03 HL141521
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
Références
Am J Surg. 2012 Jan;203(1):69-75
pubmed: 22172484
Scand J Trauma Resusc Emerg Med. 2009 Sep 26;17:48
pubmed: 19781093
Am J Surg. 2014 Feb;207(2):170-8
pubmed: 24468024
J Surg Educ. 2012 Mar-Apr;69(2):236-40
pubmed: 22365872
Med Educ. 2006 Nov;40(11):1098-104
pubmed: 17054619
Postgrad Med J. 2017 Aug;93(1102):449-453
pubmed: 27986970
Am J Emerg Med. 1996 Oct;14(6):564-9
pubmed: 8857806
J Trauma. 2008 Feb;64(2):255-63; discussion 263-4
pubmed: 18301184
J Appl Psychol. 2005 Nov;90(6):1288-96
pubmed: 16316282
J Surg Educ. 2011 Nov-Dec;68(6):472-7
pubmed: 22000533
JAMA Surg. 2019 Mar 1;154(3):257-258
pubmed: 30601875
Am J Surg. 2018 Sep;216(3):630-635
pubmed: 29366483
J Crit Care. 2008 Jun;23(2):188-96
pubmed: 18538211
Injury. 2018 Sep;49(9):1687-1692
pubmed: 29866625
J Trauma. 1995 Jan;38(1):79-82
pubmed: 7745665
J Trauma. 2009 Dec;67(6):1412-20
pubmed: 20009695
Surgery. 2014 May;155(5):902-9
pubmed: 24468038
Trauma Surg Acute Care Open. 2018 Oct 9;3(1):e000201
pubmed: 30402559
Am J Surg. 2008 Aug;196(2):184-90
pubmed: 18558392
Hum Resour Health. 2013 Nov 05;11:57
pubmed: 24188523
N Engl J Med. 2019 Feb 14;380(7):684-688
pubmed: 30763193
J Surg Educ. 2010 Nov-Dec;67(6):439-43
pubmed: 21156305
J Trauma. 1988 Apr;28(4):435-40
pubmed: 3352005
Injury. 2005 Aug;36(8):905-11
pubmed: 15998511
J Surg Educ. 2012 May-Jun;69(3):428-31
pubmed: 22483149
J Trauma. 1997 Nov;43(5):772-7
pubmed: 9390488
Scand J Trauma Resusc Emerg Med. 2010 Aug 31;18:47
pubmed: 20807420
J Surg Educ. 2015 Jul-Aug;72(4):732-9
pubmed: 25817012
J Surg Res. 2016 Jul;204(1):176-82
pubmed: 27451884
J Am Coll Surg. 2014 Sep;219(3):545-51
pubmed: 25026871
Aust N Z J Surg. 1999 Mar;69(3):183-6
pubmed: 10075356
Open Access Emerg Med. 2010 Jan 20;2:7-16
pubmed: 27147832
Pediatrics. 2006 Mar;117(3):658-64
pubmed: 16510644
Acta Anaesthesiol Scand. 2014 Aug;58(7):775-87
pubmed: 24828210